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Individual

AHMAD MAHALLATI-SHIRAZI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD60221637
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1043423775
WA
05
413127400
MD
01
925031-01
BLUE CROSS/BLUE SHIELD
MD
01
P00981400
RAILROAD MEDICARE
WA
01
S062-0323
BLUE CROSS/BLUE SHIELD REGIONAL
MD
Enumeration date
05/08/2007
Last updated
06/25/2013
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